At the Epicenter: An Interview With Northwell Health CEO Michael Dowling

Dowling speaks about the opportunity to lead during the COVID-19 pandemic.

The New York City metropolitan area has become the epicenter of the U.S. COVID-19 outbreak, with almost 15,000 cases in the NYC boroughs alone and more than 25,000 in the state. At the center of the epicenter is Northwell Health, the largest health system in the state with 23 hospitals and 72,000 employees.

While New York Governor Andrew Cuomo and New York City Mayor Bill de Blasio warn that the outbreak could cripple the state’s public hospitals, CEO Michael Dowling has been working to communicate daily with his team and manage capacity while also hoping Northwell’s research arm will contribute to the global rush for effective treatment.

During a rare moment to pause, Dowling spoke with HealthLeaders editor Jim Molpus about the opportunity to lead right now.

HealthLeaders: How do you prioritize at a time like this when the clinical situation changes daily?

Dowling: It's not that hard. Bottom line: one, is making sure you provide the best care you possibly can to the patients who have come to you, even though the clinical criteria sometimes change. The second is taking care of your staff by making sure they have the proper protection. Because if your staff gets sick, then you have a huge problem. The key to all of this is making sure we have the right staff and are doing things the right way.  

HL: What is your supply situation right now?

Dowling: The whole supply chain has been disrupted and that's becoming a difficult, difficult thing. A major focus is to make sure we have enough masks, and the right kinds of masks, because we use up thousands of masks a day. When you add up the N95s and all, we use up to 6,000 masks a day. We have an inventory that goes down every day unless you continue to replenish. We are in a lucky position right now to have an adequate supply of masks and more coming on the way.

HL: How are you managing bed capacity?

Dowling: Inside every hospital you can create more beds. Everybody can do it. Any hospital that says they can't do it must be completely chock-full. In New York City, we have identified thousands of thousands of beds that could be collated. And also, we're looking at what outside locations would be available for extra beds. And you focus on communicating, communicating, communicating with your staff and with the public, and making sure the public understands they have a big part in this. If they're not compliant with the public policies, then we're going to prolong it longer than we should.

HL: Let's talk about that because it's inevitable that you start to see some commentary about social distancing being loosened and the president had comments about it last night.

Dowling: This is the tradeoff. I think we've got the social distancing thing for a while. I mean, I understand the other economic side of the equation, but if you don't, and this thing takes off again, you'll have an awful lot of sick people left out. We will have vulnerable people dying and we will completely overwhelm the healthcare system. We can sustain this level of activity for a number of weeks or a month. But if it goes on for months and months, then we've got a big issue. So, it's a difficult tradeoff. I know that we’ve got to get back to work. I don't think anybody disagrees. The question is, when?

HL: Northwell recently announced two clinical trials for COVID treatment. That's pretty exciting. And you know, I think people are looking for any positive signs about treatment. What’s the outlook for those?

Dowling: Northwell is involved in what are called treatment trials. We are taking an approved drug (Gilead’s remdesivir) and giving it to patients on a trial basis to see whether it acts against the virus in COVID patients. So, we're in the midst of that trial. Many other places are doing the same thing. And I do believe that in the next week or two, we will find out if some of these drugs will have an impact. In talking to the scientists or the people who are doing the clinical trials, their perspective is one of reasonable optimism that we would be able to get something that can help the people who are really sick.

HL: As an experienced CEO, you have been through all sorts of challenges, including, of course, 9/11. Some of your team members and those in the community may not have been through a sustained crisis. How do you keep everyone's spirits up?

Dowling: The key to me is communication. You’ve got to be calm. You have to be upbeat. You must also give people data. I just did another video for employees this morning, which is basically saying this is a tough time. But this is why you got into healthcare to begin with. You got in this business because you want to do good. It's not going to be easy every day. It's going to be hard.

And then when the really hard day comes, suck it up more. And just by doing that, they will know we're all in this together, but it's constant, constant communication. My one last caveat, though, is that calm will depend on them being sure they have the protection, the PPE equipment, available to them. If you went to them and said, "By the way, beginning today, I have no masks, that would be a whole other problem."

HL: I hate to say it, but healthcare has an elaborate supply chain and purchasing infrastructure. What went wrong with masks and other protective equipment?

Dowling: Oh, sure. But remember, a lot of that was made in China. Most of our masks come from China. So, all the factories in China shut down and China needed to use up the inventory. Now some of the factories are back to production in China. Some, not all. Some other companies like 3M are ramping up mask production.

HL: New York, I think I read today, has 5% of worldwide cases right now.

Dowling: We are the epicenter, right.

HL: Any advice for your fellow CEOs in Dallas, or Atlanta, or New Mexico, wherever; where it's coming someday?

Dowling: I would say, even if you don't think it's coming, prepare as if it was already there. Start doing the inventory. Look at your capacity plans and discard any that are old. Begin to identify the staffing you would need and how you might want to deploy staff. Start giving the message that no matter what happens to us, we will win. Tune out the noise on television that will whiplash you and your team.  

You've got to have optimism during a crisis like this. You've got to communicate with your staff on an ongoing basis. You've got to stay calm and you've got to make sure people understand that. Begin to set up your emergency operations center that will manage the situation in a crisis like this. You've got to be creative and adaptable because the way you normally do business goes out the window. Be creative every single day. And that's what leadership does.